Research News

Researchers urge further study of venous abnormalities

By ELLEN GOLDBAUM

“We are calling for additional research into understanding the role of the extracranial venous system in relation to a broad range of central nervous system disorders and aging.”

Robert Zivadinov, professor

Department of Neurology

UB researchers who authored one of neurology’s most cited
papers in the past three years are calling for more investigation
into how venous abnormalities in the neck might be involved in
central nervous system disorders and aging.

The call for additional research was expressed in a December
editorial and debate article in BMC Medicine co-authored by Robert
Zivadinov, professor of neurology in the School of Medicine and
Biomedical Sciences and director of the neurology
department’s Buffalo Neuroimaging Analysis Center.

Zivadinov and his colleagues published a paper on the prevalence
of these abnormalities in multiple sclerosis (MS) patients in 2011.
The paper is one of the top 10 articles in neurology and the
second-most-cited paper in neurology since its publication,
according to Neuropenews, the news blog of the European Federation
of Neurological Societies and the European Neurological
Society.

“Interest in these venous abnormalities is reflected by
the large number of citations of the 2011 paper, but the full story
and consequence of these abnormalities will require much more
research,” says Zivadinov. “To that end, we are calling
for additional research into understanding the role of the
extracranial venous system in relation to a broad range of central
nervous system disorders and aging.”

In their December 2013 article, “Potential involvement of
the extracranial venous system in central nervous system disorders
and aging,” Zivadinov and his co-author Chih-Ping Chung of
Taipei Veterans General Hospital discuss the history of these
venous abnormalities, noting that since no causal relationship was
found with MS, there have been some calls to abandon related
research.

But Zivadinov and Chung say that given the mounting evidence
that vascular factors may play a role in a range of central nervous
system disorders, more research on extracranial venous
abnormalities is essential. In particular, they call for research
that can examine the incidence and prevalence of these venous
abnormalities in relation to developmental and demographic factors,
as well as cardiovascular, inflammatory and lifestyle risk
factors.

Extracranial venous abnormalities, indicative of chronic
cerebrospinal venous insufficiency (CCSVI), were described
initially by Paolo Zamboni of Italy’s University of Ferrara.
The condition is characterized by the narrowing of vessels draining
blood from the cranium. Zamboni had hypothesized that this
narrowing restricts the normal outflow of blood from the brain,
resulting in alterations in the blood flow patterns within the
brain that eventually cause injury to brain tissue and degeneration
of neurons, leading or contributing to MS.

The July 2011 paper co-authored by Zivadinov, “Prevalence,
sensitivity, and specificity of chronic cerebrospinal venous
insufficiency in MS,” was published in Neurology. It
described a UB research study designed to determine the prevalence
of CCSVI in a large cohort of patients with multiple sclerosis,
clinically isolated syndrome or other neurologic diseases, as well
as healthy controls.

In that study, researchers found an increased prevalence of
CCSVI in MS, but it was substantially lower than the sensitivity
and specificity rates in MS that the Italian investigators
originally reported.

“We began with a major investigation into extracranial
venous abnormalities with relation to MS patients and have now
developed a substantial body of work looking at them in relation to
Alzheimer’s disease, aging and other neurological
diseases,” says Zivadinov. “The work has been of
critical interest to the scientific community. We believe that our
current studies on how these abnormalities impact central nervous
system pathology will also prove to be of ongoing
interest.”